The Thyroid Doctor's log after seeing his patients. I am a rare bird. I am one of the few physicians to practice clinical thyroidology only for 35 years. I am the sole physician at the Santa Monica Thyroid Center, and have the best thyroid blood lab with Dr.Carole Spencer, expert in thyroid hormone analysis, and thyroid cancer markers, as my lab director.The lab is also CLIA certified in thyroid cytology. Dr.Guttler is a thyroid ultrasonographer certified by AACE, and AIUM.

Thursday, April 30, 2009

The answer to this Ask the Doctor email is yes. The finding of an elevated TSH or even a slowly increasing TSH over a few years is a clue to the onset of hypothyroidism. The abnormal TSH should be the starting point to investigate the cause of the failing thyroid and to evaluate the structure of the gland. TSH elevation even in the upper normal range has been found to be a risk factor for thyroid cancer. All newly diagnosed patients with TSH 2.5-10 are in the risk pool for cancer. The primary physician may not even feel the patient's neck before starting therapy. The thyroid gland is almost always abnormal to physical examination by a clinical thyroidologist. Firm gland with cobble stone surface is usually missed by the primary physician. Before allowing the physician to treat you, you need a complete thyroid evaluation looking for nodules. The endocrine neck ultrasonographer thyroidologist will do a detailed study of the thyroid, lymph nodes and parathyroid areas. If a suspicious nodule or lymph node is found, an ultrasound guided FNA will be done. Modern thyroidology concepts include hands on ultrasound real time done by your thyroidologist or endocrinologist, not by a radiology tech, who prints out pictures for a radiologist to look at after the fact. The original evaluation when the abnormal TSH is found is the best time to see a clinical thyroidologist, notjust start thyroid hormone.

3 comments:

Thank you for providing such an informative blog. I must admit 'TSH' 'T4' all the terms and levels are so confusing to me. Please take a look at my writings and pictures, let me know what you think. It might be interesting to you or maybe not...

I have taken thyroid medicine in the past, ran out 1 1/2 months ago while waiting for a new primary care Dr. and began to have symptoms very similar to the problems I have had recently with my heart. They did a TSH and found it to be a 36. The urgent care Dr gave me a refil of my old perscription. Now that I am reading up on Hypothyroidism should I be doing something before my Dr's apt in 3 weeks? LCL

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About Me

Dr. Guttler has been a Thyroid Expert for 36 years, board certified in internal medicine, and endocrinology, Clinical Professor of Medicine, Keck School Medicine USC. He was the past president and founder of the Academy of Clinical Thyroidologists, www.thyroidologists.com. He is certified by the American College of Endocrinology in Endocrine Neck ultrasound, ECNU. His Endocrine Neck Ultrasound of Southern California is certified for referrals by the American Institute of Ultrasound Medicine AIUM. Beginning in Jan.2009, he is teaching 3 day master's classes in thyroid ultrasound. These will be open to all interested in the endocrine neck. www.thyroid.com/class.html
Dr. Guttler is the director of a world class thyroid center, with capability to do all aspects of thyroid diagnosis, and treatment.
Dr. Guttler's Thyroid Home Page is at:
http://www.thyroid.com.
It is one of the first private thyroid sites on the web.He is the director of the Endocrine Neck Ultrasound Lab of Southern California.
www.endocrineneck.com